Provider Demographics
NPI:1952795734
Name:SEGARRA, ADELAIDA (RD, LND, ENPR, CLE)
Entity Type:Individual
Prefix:MRS
First Name:ADELAIDA
Middle Name:
Last Name:SEGARRA
Suffix:
Gender:F
Credentials:RD, LND, ENPR, CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:H4 CALLE D
Mailing Address - Street 2:URB BAIROA GOLDEN GATE I
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1138
Mailing Address - Country:US
Mailing Address - Phone:787-226-2079
Mailing Address - Fax:
Practice Address - Street 1:SUITE L32 JOSE GARRIDO AVE.
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1872133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered